Managing Gout

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Gout is a common, painful form of arthritis. Once called the “disease of kings,” it’s now known that men and women of all ages can get this disease. While there is no cure for gout, modern medical treatments can help those with the disease manage their symptoms.

As medical office assistants, unit clerks, and pharmacy assistants, our graduates will likely encounter those with gout in the workplace. Here are some things frontline healthcare workers need to know about the disease and how to manage it.

What Causes Gout?

Gout is caused when uric acid crystals are released into a joint, resulting in inflammation, pain, and swelling.

When the body has either produced too much uric acid, or not enough uric acid is filtered out of the blood by the kidneys, these crystals form. Alcohol, some medications such as aspirin, and some foods—including liver and other organ meats, sardines, anchovies—can cause high uric acid levels. Attacks of gout may occur at any time, but injuries, surgery, acute illness, and over-indulgence in fatty foods and alcohol can trigger them.

What are the Symptoms of Gout?

The most common symptom of gout is sudden, intense joint pain and swelling. Joints may feel hot and tender and turn red. Even lightly touching the affected joint can cause severe pain, which is usually continuous if the joint is moved.

A sudden attack of gout usually lasts several days. These attacks can happen at any time, either several years apart or seemingly back to back. Some who suffer from gout can have long-lasting, constant pain. Everyday activities, such as walking, dressing oneself, and lifting heavy objects, may become difficult or painful to do.

Gout can occur in any joint, but feet are the most common joint affected. Most typically, it afflicts the big toe. However, gout can also occur in the hands, ankles, insteps or knees.

How is Gout Diagnosed?

A health care provider will make the diagnosis based on medical history and physical examination. The health care provider may choose to perform blood tests, but these can be unreliable since uric acid levels can vary throughout a gout attack. The only sure way to diagnose gout is to use a needle to drain fluid from the joint. This fluid is then checked to see whether it contains uric acid crystals.

How Is Gout Treated?

Gout attacks can be treated and prevented. Nonsteroidal anti-inflammatory drugs or NSAIDs, such as indomethacin and naproxen, are commonly used for treatment. Other drugs that may be prescribed include colchicine and prednisone. Removal of fluid from the joint, followed by cortisone injection, is another treatment. Cortisone injections usually give the fastest and best relief of pain and swelling.

After attacks are treated, symptoms usually go away within hours to a few days. Untreated attacks may last several days.

Individuals with high blood uric acid levels are more likely to have multiple attacks. High uric acid levels that persist for several years can cause uric acid deposits under the skin, called tophi. Active prevention is needed for people with tophi, as they can lead to both kidney stones and frequent gout attacks. In these cases, the healthcare professional will usually prescribe medication to help in lowering uric acid levels. Medications, including allopurinol, febuxostat, and probenecid are prescribed to control acute and chronic conditions.

Dos and Don’ts of Managing Gout

Woman and nurse
  • DO rest the affected joint until symptoms start to improve.
  • DO take your medicines as prescribed.
  • DO ask your health care provider which over-the-counter medicines you’re allowed to take.
  • DO make lifestyle changes to prevent attacks. Lose weight if you are very overweight. Avoid liver and other organ meats, sardines, and anchovies, which may increase uric acid levels. Stop drinking alcohol.
  • DO call your health care provider if you have medicine side effects or medicine doesn’t help symptoms.
  • DO call your health care provider if you begin to lose movement in the joint.
  • DO call your health care provider if you have warmth, redness, or pain after a cortisone injection.
  • DON’T drink alcohol. Too much alcohol can cause gout.
  • DON’T start medications that lower uric acid, such as allopurinol or febuxostat, immediately after an attack subsides. This may prolong the attack or another gout attack. It’s best to wait several days after an attack subsides before starting these medications.

The Role of Pharmacy Assistant in Treating Gout

Pharmacy Assistants provide focused care to a rapidly growing base of patients with gout and other arthritic conditions. In dealing with patients with gout, pharmacy assists will assist in managing patient pharmacy profiles, and preparing medications, both over-the-counter and prescription.

Role of Medical Office Assistants in Treating Gout

Medical Office Assistants can help those who suffer from gout by proactively identifying patients who would benefit from an office visit, reviewing medical adherence according to clinical guidelines, and ordering labs and prescription refills based on protocols.

References:

  • Ferri’s Netter Advisor for Health Professionals
  • CTC 2019 Canadian Pharmacist Association
  • CTMA 2019 Canadian Pharmacist Association
  • Merck Manual 2018, Merck Publishing

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